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“Well-meant protectiveness gradually undermines any autonomy.” *

In occupational therapy, it is our job to help people reach their goals of becoming more independent in every day life.  I think the above quote is important because it reminds us that if we help people for too long, without allowing them a chance to try for themselves because we want to protect them from failure, we may actually end up doing them more harm than good.

While I’m sure there are many techniques out there that instructors can use to assist learners without undermining their autonomy, I have two favorites: scaffolding and modeling.

(1) Scaffolding is a technique that gets a lot of attention in the realms of education and child development.  Essentially, it acts as a bridge between what learners can already do and what they can’t yet do on their own. The instructor is encouraged to offer assistance to a learner only in the area that is not yet mastered.  Mistakes are expected, and the instructor can respond to them with positive feedback about how to improve.  Once the skill is nearly mastered, then the instructor can begin to fade out the assistance being given so that the learner can proceed to perform the newly learned skill on his or her own.  There are many strategies for effectively facilitating a scaffolded approach, and both the learner and instructor need to make sure that the target skill is neither too easy nor too hard, so that they will be presented with the “just right” challenge.  The concept of scaffolding relates to Vygotsky’s “Zone of Proximal Development” (ZPD).  The ZPD is the distance between what a learner can actually do by him/herself, and what the learner can do with the help of a more knowledgeable adult or peer.  As people learn, their ZPD is constantly shifting to adjust to their newly learned skills.

It seems obvious how scaffolding relates to occupational therapy, but I think it is something that is easy to lose sight of as life moves forward at a rapid pace.  Whether it is an OT who is teaching a child how to properly hold a pencil and write his name, or who is helping a stroke survivor learn how to independently feed herself, scaffolding is one of those concepts that I believe will never get old.  It is meant to enable people’s abilities, and if our job as occupational therapists is to give power to those who are working to gain it, then I believe scaffolding can be one of our most potent tools.

(2) Modeling is a concept taken from Albert Bandura’s Social Learning Theory in the 1970’s.  Without going into too much detail, Social Learning Theory has been one of the most influential theories about learning, and it states that learning through observation is one of the most powerful ways in which we learn, and that it can account for many types of behavior.  This theory informs many fields, including sport psychology (to which I devoted much of my undergraduate experience), where some observational learning techniques may include watching a coach or another athlete perform a skill well (either in person or on video), watching a video of oneself performing a skill well, or visualizing oneself doing a skill perfectly.  These are all techniques that lend themselves to learning through observation (real or imagined).   Additionally, my pediatric development class in OT school has taught me that, in the second year of life, children learn mostly through observation and imitation (as opposed to exploration, as they do in their first year of life).  I’m sure you could think of several other instances – as could I – in which observational learning is a viable mode of attaining or improving a new skill.

In the world of occupational therapy, I think that modeling can be used as part of a scaffolding approach to teaching new skills.  Perhaps, if you as an occupational therapist are trying to teach someone how to use a walker, and he or she is having a difficult time following verbal instructions, modeling can be used to show the proper technique.  Or if you want to teach someone a safer position in which to sleep due to recent hip surgery, and it’s too complicated to describe with words, simply modeling the appropriate position can be a powerful teaching tool.  Simply stated, modeling can succeed where words fail.  That’s not to say that verbal instructions are useless.  But modeling proper behavior is a powerful technique that can be used as the foundation for many important teaching moments.

As an OT student, in my eagerness to learn how to help people become more independent in their everyday lives, I know it will be important to remember that well-meant protectiveness can gradually undermine autonomy.  This doesn’t mean that I have to resist temptation to help people when it seems that they’re struggling.  It simply means that I need to be mindful of the process through which they are moving as well as the strategies that I am implementing in order to help them attain their goal.

*The opening quote was taken from page 87 of Ellen J. Langer’s 1989 book, Mindfulness.  A Harvard psychologist, she explores the definitions and implications of living both mindlessly and mindfully.  Because of its detrimental effects, well-meant protectiveness which gradually undermines autonomy, then, is seen to be an indication of mindlessness.  More to come on this topic.

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